A confirmatory factor analysis of the hospital anxiety and depression scale in coronary care patients following acute myocardial infarction
Open accessAbstract
The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for coronary care patients following acute myocardial infarction (MI) was investigated. A confirmatory factor analysis was conducted on the HADS to determine its psychometric properties in 335 MI patients over three observation points (1 week, 6 weeks and 6 months). Internal and test-retest reliabilities of the HADS total and HADS sub-scale scores were generally found to be acceptable. The underlying factor structure of the HADS comprised three distinct factors. Support was found for the use of the HADS sub-scales to assess dimensions of anhedonia, psychic anxiety and psychomotor agitation. The HADS may be a useful screening instrument to assess post-MI patients for symptoms of psychological distress. Further research is required to determine the three-factor structure of the HADS in other clinical groups.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The Hospital Anxiety and Depression Scale (HADS) has good psychometric properties and is widely used on patients with somatic diseases, including cardiology patients.
“HADS has good psychometric properties and is widely used on patients with somatic diseases (36, 37), including cardiology patients (38, 39).”
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Coefficient Alpha and the Internal Structure of Tests
Cronbach, L. J. (1951) · Psychometrika · doi:10.1007/bf02310555 · Cited by 43,931 · see citing works
(1998) · Cited by 36,049 · see citing works
Alternative Ways of Assessing Model Fit
Browne, M. W., & Cudeck, R. (1992) · Sociological Methods & Research · doi:10.1177/0049124192021002005 · Cited by 27,200 · see citing works
Comparative fit indexes in structural models.
Bentler, P. M. (1990) · Psychological Bulletin · doi:10.1037/0033-2909.107.2.238 · Cited by 25,266 · see citing works
Significance tests and goodness of fit in the analysis of covariance structures.
Bentler, P. M., & Bonett, D. G. (1980) · Psychological Bulletin · doi:10.1037/0033-2909.88.3.588 · Cited by 19,266 · see citing works
Testing Structural Equation Models.
Mueller, C. W., Bollen, K. A., & Long, J. S. (1994) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2074955 · Cited by 14,211 · see citing works
The validity of the Hospital Anxiety and Depression Scale
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00296-3 · Cited by 9,779 · see citing works
Testing Structural Equation Models.
Clogg, C. C., Bollen, K. A., & Long, J. S. (1995) · Social Forces · doi:10.2307/2580595 · Cited by 8,244 · see citing works
Akaike, H. (1987) · Psychometrika · doi:10.1007/bf02294359 · Cited by 5,264 · see citing works
Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications.
Clark, L. A., & Watson, D. (1991) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.100.3.316 · Cited by 4,602 · see citing works
Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications
Clark, L. A., & Watson, D. (1991) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.100.3.316 · Cited by 4,601 · see citing works
Bozdogan, H. (1987) · Psychometrika · doi:10.1007/bf02294361 · Cited by 4,468 · see citing works
Book Review: Structural Equation Modeling: Concepts, Issues, and Applications
Rigdon, E. E., & Hoyle, R. H. (1997) · Journal of Marketing Research · doi:10.2307/3151904 · Cited by 4,085 · see citing works
Hu, L., & Bentler, P. M. (1995) · Cited by 4,008 · see citing works
Goodness-of-fit indexes in confirmatory factor analysis: The effect of sample size.
Marsh, H. W., Balla, J. R., & McDonald, R. P. (1988) · Psychological Bulletin · doi:10.1037/0033-2909.103.3.391 · Cited by 3,833 · see citing works
The handbook of psychological testing
Kline, P. (1993) · Choice Reviews Online · doi:10.5860/choice.31-1802 · Cited by 3,568 · see citing works
Herrmann, C. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(96)00216-4 · Cited by 2,885 · see citing works
Alternative ways of assessing model fit
Browne, M. (1993) · Medical Entomology and Zoology · Cited by 2,595 · see citing works
Mykletun, A., Stordal, E., & Dahl, A. A. (2001) · British Journal of Psychiatry · doi:10.1192/bjp.179.6.540 · Cited by 908 · see citing works
Moorey, S., Greer, S., Watson, M., Gorman, C., Rowden, L., Tunmore, R., Robertson, B., & Bliss, J. M. (1991) · The British Journal of Psychiatry · doi:10.1192/bjp.158.2.255 · Cited by 654 · see citing works
Screening for Adjustment Disorders and Major Depressive Disorders in Cancer In-Patients
Razavi, D., Delvaux, N., Farvacques, C., & Robaye, E. (1990) · British Journal of Psychiatry · doi:10.1192/bjp.156.1.79 · Cited by 514 · see citing works
Depression and Anxiety As Predictors of Outcome After Myocardial Infarction
Mayou, R., Gill, D., Thompson, D. R., Day, A., Hicks, N., Volmink, J., & Neil, A. (2000) · Psychosomatic Medicine · doi:10.1097/00006842-200003000-00011 · Cited by 485 · see citing works
Self-citationFrasure‐Smith, N., Lespérance, F., & Talajic, M. R. (1995) · Health Psychology · doi:10.1037//0278-6133.14.5.388 · Cited by 476 · see citing works
Lane, D. A., Carroll, D., Ring, C., Beevers, D. G., & Lip, G. Y. H. (2001) · Psychosomatic Medicine · doi:10.1097/00006842-200103000-00005 · Cited by 451 · see citing works
Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS)
Ahern, D. K., Gorkin, L., Anderson, J. L., Tierney, C., Hallstrom, A. P., Ewart, C. K., Capone, R. J., SCHRON, E. B., Kornfeld, D. S., Herd, J. A., et al. (1990) · The American Journal of Cardiology · doi:10.1016/0002-9149(90)90736-k · Cited by 432 · see citing works
Construct validation of the hospital anxiety and depression scale with clinical populations
Johnston, M., Pollard, B., & Hennessey, P. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(00)00102-1 · Cited by 383 · see citing works
Frasure‐Smith, N., Lespérance, F., & Talajic, M. (1995) · Health Psychology · doi:10.1037/0278-6133.14.5.388 · Cited by 379 · see citing works
Moser, D. K., & Dracup, K. (1996) · Psychosomatic Medicine · doi:10.1097/00006842-199609000-00001 · Cited by 305 · see citing works
Post-infarction depression and incomplete recovery 6 months after acute myocardial infarction
Ladwig, K., Ladwig, K. H., Röll, G., Breithard, G., Budde, T., & Borggrefe, M. M. (1994) · The Lancet · doi:10.1016/s0140-6736(94)90877-x · Cited by 252 · see citing works
Strik, J. J. M. H., Honig, A., Lousberg, R. L., & Denollet, J. (2001) · Psychosomatics · doi:10.1176/appi.psy.42.5.423 · Cited by 244 · see citing works
Kline, P. (2000) · Cited by 228 · see citing works
Dunbar, M., Ford, G., Hunt, K., & Der, G. (2000) · British Journal of Clinical Psychology · doi:10.1348/014466500163121 · Cited by 178 · see citing works
Friedman, S., Samuelian, J., Lancrenon, S., EVEN, C., & Chiarelli, P. (2001) · Psychiatry Research · doi:10.1016/s0165-1781(01)00309-2 · Cited by 175 · see citing works
Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population
Smith, A. B., Selby, P. J., Velikova, G., Stark, D., Wright, P., Gould, A., & Cull, A. (2002) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608302169625 · Cited by 162 · see citing works
Lane, D. A., Carroll, D., Ring, C., Beevers, D. G., & Lip, G. Y. H. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(00)00170-7 · Cited by 160 · see citing works
Diagnostic Groups and Depressed Mood as Predictors of 22-Month Mortality in Medical Inpatients
Herrmann, C., Brand-Driehorst, S., Kaminsky, B., Leibing, E., Staats, H., & Rüger, U. (1998) · Psychosomatic Medicine · doi:10.1097/00006842-199809000-00011 · Cited by 146 · see citing works
Impact on Patients and Partners of Inpatient and Extended Cardiac Counseling and Rehabilitation
Johnston, M., Foulkes, J., Johnston, D. W., Pollard, B., & Gudmundsdóttir, H. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199903000-00015 · Cited by 123 · see citing works
Roberts, S. B., Bonnici, D. M., Mackinnon, A. J., & Worcester, M. C. (2001) · British Journal of Health Psychology · doi:10.1348/135910701169278 · Cited by 104 · see citing works
Chronic memory impairment after cardiac arrest outside hospital
Grubb, N. R., O’Carroll, R. E., Cobbe, S. M., et al. (1996) · BMJ · doi:10.1136/bmj.313.7050.143 · Cited by 102 · see citing works
Martin, C. R., Tweed, A. E., & Metcalfe, M. S. (2004) · British Journal of Clinical Psychology · doi:10.1348/014466504772812968 · Cited by 97 · see citing works
Self-citationThomas, S., Friedmann, E., Wimbush, F. B., & SCHRON, E. B. (1997) · American Journal of Critical Care · doi:10.4037/ajcc1997.6.2.116 · Cited by 95 · see citing works
Frasure‐Smith, N., Lespérance, F., Gravel, G., Masson, A., Juneau, M., & Bourassa, M. G. (2002) · Psychosomatic Medicine · doi:10.1097/01.psy.0000021950.04969.f8 · Cited by 89 · see citing works
A psychometric evaluation of the Hospital Anxiety and Depression Scale during pregnancy
Karimova, G., & Martin, C. (2003) · Psychology, Health & Medicine · doi:10.1080/1354850021000059296 · Cited by 80 · see citing works
Self-citationMartin, C. R., & Thompson, D. R. (2000) · Psychology Health & Medicine · doi:10.1080/713690189 · Cited by 80 · see citing works
Self-citationIn-hospital symptoms of depression do not predict mortality 3 years after myocardial infarction
Lane, D. A., Carroll, D., Ring, C., Beevers, D. G., & Lip, G. Y. H. (2002) · International Journal of Epidemiology · doi:10.1093/ije/31.6.1179 · Cited by 68 · see citing works
Trzcieniecka-Green, A., & Steptoe, A. (1996) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a014749 · Cited by 64 · see citing works
Dagnan, D., Chadwick, P., & Trower, P. (2000) · British Journal of Medical Psychology · doi:10.1348/000711200160255 · Cited by 54 · see citing works
Management of anxiety after acute myocardial infarction
Frazier, S. K., Moser, D. K., O'Brien, J. L., Garvin, B. J., An, K., & Macko, M. (2002) · Heart & Lung · doi:10.1067/mhl.2002.129445 · Cited by 51 · see citing works
Guideline-based early rehabilitation after myocardial infarction
Mayou, R., Thompson, D. R., Clements, A., Davies, C. H., Goodwin, S. J., Normington, K., Hicks, N., & Price, J. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00300-2 · Cited by 49 · see citing works
Self-citationMartin, C. R., & Thompson, D. R. (1999) · Psychology Health & Medicine · doi:10.1080/135485099106117 · Cited by 43 · see citing works
Self-citationMcCue, P., Martin, C., Buchanan, T., Rodgers, J., & Scholey, A. B. (2003) · Psychology Health & Medicine · doi:10.1080/1354850310001604568 · Cited by 41 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Prevalence of depression in survivors of acute myocardial infarction: Review of the evidence
Thombs, B. D., Bass, E. B., Ford, D. E., Stewart, K. J., Tsilidis, K. K., Patel, U., Fauerbach, J. A., Bush, D. E., & Ziegelstein, R. C. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.00269.x · Cited by 841 · see citing works
Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale
Pais-Ribeiro, J., Silva, I., Ferreira, T., Martins, A., Meneses, R., & Baltar, M. (2007) · Psychology, Health & Medicine · doi:10.1080/13548500500524088 · Cited by 774 · see citing works
Eisenberg, S. A., Shen, B.-J., Schwarz, E. R., & Mallon, S. (2012) · Journal of Behavioral Medicine · doi:10.1007/s10865-011-9358-0 · Cited by 222 · see citing works
Anxiety and depression as risk factors for mortality after coronary artery bypass surgery
Tully, P. J., Baker, R. A., & Knight, J. L. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.09.007 · Cited by 211 · see citing works
Matsudaira, T., Igarashi, H., Kikuchi, H., Kano, R., Mitoma, H., Ohuchi, K., & Kitamura, T. (2009) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-7-42 · Cited by 134 · see citing works
Alsén, P., Brink, E., Persson, L.-O., Brändström, Y., & Karlson, B. W. (2010) · Journal of Cardiovascular Nursing · doi:10.1097/jcn.0b013e3181c6dcfd · Cited by 115 · see citing works
Hanssen, T. A., Nordrehaug, J. E., Eide, G. E., Bjelland, I., & Rokne, B. (2009) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e32832e4206 · Cited by 111 · see citing works
McCue, P., Buchanan, T., & Martin, C. R. (2006) · British Journal of Clinical Psychology · doi:10.1348/014466505x82379 · Cited by 58 · see citing works
Self-citationHabibović, M., Denollet, J., Cuijpers, P., Spek, V. R. M., van den Broek, K. C., Warmerdam, L., van der Voort, P. H., Herrman, J.-P., Bouwels, L., Valk, S. S. D., et al. (2014) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000096 · Cited by 38 · see citing works
Saez-Flores, E., Tonarely, N. A., Barker, D. H., & Quittner, A. L. (2018) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsx155 · Cited by 25 · see citing works
Wells, A., Reeves, D., Heal, C., Fisher, P., Davies, L., Heagerty, A., Doherty, P., & Capobianco, L. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00582 · Cited by 18 · see citing works
Wells, A., Reeves, D., Heal, C., Fisher, P., Doherty, P., Davies, L., Heagerty, A., & Capobianco, L. (2022) · Health Psychology · doi:10.1037/hea0001168 · Cited by 11 · see citing works
Larionov, K., Petrova, E., Demirbuga, N., Werth, O., Breitner, M. H., Gebhardt, P., Caldarone, F., Duncker, D., Westhoff-Bleck, M., Sensenhauser, A., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1138475 · Cited by 1 · see citing works
“HADS has good psychometric properties and is widely used on patients with somatic diseases (36, 37), including cardiology patients (38, 39).”
- Authors
- Martin, C. R., Lewin, R. J. P., & Thompson, D. R.
- Affiliations
- University of York (GB)
- Corresponding author
- Martin, Colin R.
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2003-08
- Volume
- 120
- Issue
- 1
- Pages
- 85-94
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2084605848
- Cited by
- 115
- References
- 52
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 9 · 2016: 3 · 2015: 4 · 2014: 8 · 2013: 7 · 2012: 8
- FWCI
- 5.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.scopus.com
- Licence
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- Hospital Anxiety and Depression Scale, acute myocardial infarction, psychological distress screening, psychometric properties, factor structure, anhedonia, psychic anxiety, psychomotor agitation, test-retest reliability, internal consistency
- MeSH terms
- Aged, Aged, 80 and over, Anxiety, Coronary Care Units, Depression, England, Female, Follow-Up Studies, Humans, Male, Mass Screening, Middle Aged, Myocardial Infarction, Personality Inventory, Psychometrics, Psychomotor Agitation, Sick Role, Reproducibility of Results
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
